Tuesday, January 08, 2008

The New Cardiology Patient

"Everything. The world is changing so fast. I mean, look at the news! Even Hillary might not win New Hampshire!"

Doctor looks puzzled.

"And Doc... oh, my God... Doc, I mean people like me... well, they could have a heart attack... you know, the Big One. Did you hear? Holy Mackerel! Can you believe it? I mean, what about my kids, my wife? Who'll be there when I'm gone? And what about my new HD TV system that I got for Christmas?How will we pay the bills? And my taxes in April? Doc, can I use your sink? I need to wash my hands. Really, can I?"

"Uh, sure."

"Oh, thank you, Doc! How can I ever repay you!" Proceeds to wash his hands again and again.

"Doc, I was wondering..."

"What's that?"

"Can I get some Xanax? And maybe some of that butterfly medicine. You know, the one to help you sleep? Do you think it will help?"

5 comments:

This study showed older men but these issues are typically lifetime behaviors, right? Do you see a link with certain arrhythmias and anxiety? Is there an enzyme difference in people with psychological challenges (anxiety, depression, OCD etc.)?

I wonder if ADHD will have an impact on cardiac health in 20 years? Sorry to be Curious Kb today.

I just refused to renew a pt's Xanax because it wasn't a cardiac med - referred him back to his PCP.

Will need to polish my spiel in case we have any educated cardiac pts who heard about this study.

Perhaps it will go something like this:"Yes Mr. Jones, I can give you a limited supply of X benzo. But I am also going to refer you to see mental health. They may have some skills/non-drug interventions they can teach you to deal with your anxiety. You know that these medications can be addictive and can impair your ability to drive? If you take these long term then I'm going to have to advise you not to drive."

I think its important to realize that this study was a correlational study and has NOT truly defined the role of therapy in this population of men. Your point is well taken regarding the life-long nature of such personality traits like chronic anxiety, which makes one wonder what might be the findings in a younger subgroup of men OR women - unfortunately, these groups weren't studied. Regarding the arrhythmia question - I am unaware of personality traits being directly correlated with the development of arrhythmias.

Deb - thanks-

CardioNP-Some great points. Unfortunately, studies like these are bounced around the press (even in press releases by our own American College of Cardiology) and while informative, really don't help us treat cardiovascular diseases one bit. What, am I going to tell someone "Mr. Jones, you know being anxious might give you a heart attack, so calm down." I don't think so. Also, like you, I'm not about to start prescibing routine anxiolytics. I DO think, however, that anxiolytics CAN play a role in the anxious post-MI patient at times as they can help decrease catecholamines in certain particularly anxious patients.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.